Bad Karma — Or Dumb Luck

For some strange reason every time I have ever had a medical event the chatter back at the office has always made it sound worse than it really was. An episode in 2002, which resulted in a stent being installed in one of my arteries, would later be described as a heart attack. A few years later a second stent was successfully installed — it became a stroke among some back at the office.

At that point I decided to turn the phenomenon into a joke. So, when I went in for a knee replacement last January, I came back to work with a wild-eyed story for the troops: The operation went fine, though I did go brain dead for 8 to 10 seconds during the procedure. In telling it, I added a small wrinkle for effect: was it 8 to 10 seconds, or 8 to 10 minutes — I couldn’t remember. To which one of our office wiseguys rejoined: We thought it was 8 to 10 years.

But now, all kidding aside, last Wednesday, September 17, I really did go brain dead for one fateful moment as I was trying to move some pieces of furniture out of our old office at 12 Roszel Road. A colleague was holding the counter top at the high end, I was on the low end. When my left foot missed a step I went flying, crash landing on the steel landing three steps below.

The brain dead moment came when I had the chance to use the handrail but did not.

Fortunately it was followed by one of my more enlightened moments. After somehow springing back to my feet, I realized I had better sit back down and collect myself. Discovering that my left leg could bear zero weight, I dispelled the talk of being helped to my car and instead dialed 911.

The Twin W rescue squad of West Windsor arrived within minutes, I was at the Princeton Hospital emergency room minutes after. Not much more than 90 minutes later, after X-rays and a CT scan, the diagnosis was back: The pelvic bone was broken in at least two and possibly three places.

A few hours after that orthopedic surgeon Thomas Gutowski (the same surgeon who replaced my right knee eight months ago) reviewed the charts and stopped by to give me his evaluation: The good news was that surgery could be avoided, the bones would heal by themselves, with no long-term arthritis or other debilitating after-effects. The bad news was that it would take two or three days in the hospital, several more days in a rehabilitation facility, and then four to six weeks of life without bearing any load on my left leg.

As someone told me in the hours after this accident, feelings of frustration and stupidity are common. My torment was complicated by a huge sense of embarrassment. The accident was Wednesday, September 17, the same day U.S. 1 published a cover story on whether there were any practical ways to cut healthcare costs. Part of the story was focused on workplace wellness plans. The other — inspired by an architectural review printed last month in the New York Times — was a follow-up story on the brand new Princeton hospital. What was paying off, and what wasn’t, at the $522 million new facility on Route 1 in Plainsboro?

To illustrate the story, I chose a photographic representation of a bird’s eye view of the new standard design for the hospital’s 238 rooms. I put the image right on the cover of the paper that came out on Wednesday. I am not sure what route our deliverer took to the Princeton hospital that day, but I could not have gotten there much later than him.

Diccon Hyatt of U.S. 1 wrote the hospital design story for us, and in fact visited one of the signature rooms on Monday, on a brief tour with Barry Rabner, the hospital CEO. As Hyatt noted in a get well E-mail: “I could have fact-checked the story over the phone. You didn’t have to go test it yourself.”

Hyatt was kidding, of course, but his E-mail got me thinking. This was a chance for me to test the room. And even though the room has already been tested by hundreds and thousands of patients, before and after construction, I now had a chance to judge it from an unusual point of view: I was under orders for bed rest, no weight bearing on my left leg, essentially confined to bed or a wheelchair until I mastered the art of using a walker with only one good leg.

That’s a little worse off than the typical knee replacement patient. As I pointed out in my June 25 article chronicling the installation of my knee, advances in surgery and anesthesia now enable knee recipients to bear weight on the new joint within hours of its installation.

Not so, I have discovered, for a person with a broken pelvis. In that sense, I was closer to the position of an esteemed architect also quoted in that New York Times article, Princeton’s Michael Graves. He contracted viral meningitis 11 years ago and has been confined to a wheelchair ever since. As he was quoted in the Times: “Most hospital architects are not experts at health care design, because they have probably never been in a wheelchair.”

So, even though I hope not to be immobile for long, I decided to critique the new hospital room from the point of view of a person confined to bed or a wheelchair: What matters, what doesn’t?

First off these rooms are amazing, and the fact that they are all singles is icing on the cake. Even the things that Rabner mentioned as shortcomings in the new room are not significant from the patient’s point of view. Yes, the clock could have been placed in a better position, but visitors can wear watches, or check their cell phones, or walk a few feet to get a view. Another aggravation: The ventilation system that showers the visitors’ couch along the window with cold air when the AC cranks up. My guest noted that very phenomenon and was able to solve the problem by putting on a sweater.

For the wheelchair bound, and those who cannot get out of bed without assistance, other challenges arise. The sink in the bathroom is too high, though I am not sure how that could be fixed without making it too low for everyone else.

The classic rolling hospital bed table is a godsend for any patient at any time. But for a person in bed maneuvering the table is a constant challenge. A cord underneath the wheels will make it immobile. A tray or laptop at the far end becomes too heavy to lift.

From my wheelchair perspective the most critical design elements of the hospital room were controls — and control.

The nurse’s call button is a lifeline when you are confined to bed. So are your cellphone and laptop. All too soon they will need to be recharged. But no electrical outlet is within reach.

My suggestion here might also solve the bedside table problem mentioned above: Two rolling tables, one for food, drink, and care-related items, the other (outfitted with a charging dock) for reading material, electronics, and similar personal items. They could each be smaller than the standard one now used and thus more maneuverable for the person in the bed.

It’s easy to say that nurses are there to help you in that moment when the cell phone loses its charge, or when you need the paper on the chair five feet away. (And the nurses here, to a person, were all helpful without a hint of aggravation.) But that’s where control comes in. Anyone confined to bed or a wheelchair soon gets tired of asking for help at every turn. Every act you can control, no matter how small, is a reminder that some important part of you still functions.

I suspect many people in a wheelchair have a moment when they realize that whatever force put them in the chair also could have done much more to them. In my case I could have cracked my skull open or broken my neck. When I told people about the weird coincidence of the editor ending up in the same place that appeared on the same day on his cover, some started talking about karma.

But maybe it was just bad luck. Or — thinking back to my failure to use that handrail — dumb luck.